Methadone Maintenance Treatment Participants Research Articles

Pilot trial of a recovery management intervention for heroin addicts released from compulsory rehabilitation in China

China faces the challenge of dual epidemics of drug use and HIV/AIDS. Despite the high relapse rate among heroin addicts released from compulsory rehabilitation facilities, there are few programs available in China to assist these addicts in the community. We pilot-tested in China a Recovery Management Intervention (RMI) program designed to facilitate early detection of relapse and prompt linkage from compulsory rehabilitation to the community and, if participants relapse, to community-based methadone maintenance treatment (MMT) programs. One hundred heroin addicts were randomly assigned to either the Standard Care group (n=50) or the RMI group (n=50). At the end of the 3-month trial, participants in the RMI group, relative to the standard care group, demonstrated positive outcomes in recidivism due to relapse (0 vs. 6%, p=.08; d=0.354), MMT participation (8% vs. 0, p=0.06; d=0.417), and employment (33% vs. 2%, p<.001; d=0.876), although no difference was found in urine testing results (8.5% vs. 8.7%; d=0.013) among interviewed participants. These pilot study results were based on a small sample size and short-term observation, suggesting the need for more research to further improve and test RMI effectiveness with larger samples over a longer period of time in order to provide evidence in support of RMI as an effective strategy for community reintegration among addicts released from rehabilitation facilities in China.

Predictors of the severity of depressive symptoms among intravenous heroin users receiving methadone maintenance treatment in Taiwan: An 18-month follow-up study.

This 18-month follow-up study examined the predictors of the severity of depressive symptoms among intravenous heroin users receiving methadone maintenance treatment (MMT) in Taiwan. The severity of depressive symptoms in 368 intravenous heroin users receiving MMT in southern Taiwan was assessed using the Center for Epidemiological Studies Depression scale at baseline and at 3, 6, 9, 12, 15, and 18 months of treatment. Demographic and substance-using characteristics, severity of heroin use, HIV serostatus, criminal record, and family function were collected during baseline interviews. Data on methadone dosage at each follow-up interview and the duration of retention in the MMT program were also collected. A generalized estimating equation was used to determine independent predictors of depressive symptoms during the 18-month period of MMT. Female gender, lack of fixed employment, severe heroin use, concurrent methamphetamine use, low family function at baseline, heroin use during the MMT, low methadone dosage, and short duration of participation in MMT predicted more severe depressive symptoms during the 18-month MMT. This study found that sociodemographic and substance-using characteristics at baseline predicted the severity of depressive symptoms among heroin users receiving MMT. Methadone dosage and MMT duration were also predictive of depression severity. The predictors found in this study can be used to identify heroin users who are at risk for depressive symptoms in the MMT program.

Mortality among a cohort of drug users after their release from prison: an evaluation of the effectiveness of a harm reduction program in Taiwan

To determine the effect of methadone maintenance therapy (MMT) on mortality among injection drug users. A cohort of prisoners with a history of injecting opiates who were followed after their release from prison in July 2007. Mortality between July 2007 and December 2008 was determined by linking the National Death Registry with the Methadone Maintenance Treatment (MMT) database. Taiwan. A total of 4357 amnestied prisoners with a history of opiate injection. The total mortality rates (MR) among the cohort were calculated based on their person-time contribution to methadone attendance and re-incarceration during follow-up. We used survival methods with MMT and re-incarceration as time-varying covariates adjusted for length of follow-up in the community. A total of 142 deaths occurred: 13 in the 1st week after release [MR = 13.7/100 person-years (pyrs)], which was greater than that in the next 4 weeks [MR = 3.2/100 pyrs, relative rate (RR) = 4.3, P < 0.001]. Overall, 1982 (46%) subjects enrolled in MMT; however, 1282 of them discontinued MMT after enrolling. The mortality among those who continued in MMT attendance was lower (MR = 0.24/100 pyrs) than those who never enrolled in MMT (MR = 2.6/100 pyrs) or those who enrolled but dropped out of MMT (MR = 7.0/100 pyrs) after adjusting for age, gender and human immunodeficiency virus status at amnesty (RR = 0.07). In ex-prisoners in Taiwan with a history of opiate injecting, enrollment and continued participation in methadone maintenance treatment is associated with substantially lower mortality.

Trends in methadone maintenance treatment participation, retention, and compliance to dosing guidelines in British Columbia, Canada: 1996–2006

Aspects of methadone maintenance treatment (MMT) delivery, particularly daily dosing practices, are associated with longer retention in treatment. Our objective was to identify trends in compliance to MMT dosing guidelines at the population level in British Columbia, Canada, from 1996 to 2006. Analysis of a provincial drug dispensation database identified 31,724 MMT episodes initiated during the study period. The number of patients in treatment increased from 2,827 in 1996 to 9,601 in 2006. Long-term retention (>36 months) was achieved in 20%–25% of all episodes. Compliance to minimally effective dose guidelines, which is independently associated with retention, fell from 2001 to 2006. Accordingly, this decline was mirrored by 12-month retention figures, which fell from 45.9% in 2001 to 40.5% in 2005. Our evaluation has both highlighted the successes of the British Columbia Methadone program and identified aspects that may be improved to ensure safety and maximize the benefits of MMT.

Alcohol dependence and mood state in a population receiving methadone maintenance treatment.

The aim of this study was to assess the prevalence of alcohol dependence and anxiety and depressive disorder symptomatology among heroin users in drug treatment. Fifty-five clients on methadone maintenance treatment programmes in Dublin were interviewed. Prevalence rates were found to be 56% [n = 31] for alcohol dependence, 56% [n = 31] for anxiety disorder symptomatology, and 42% [n = 23] for depressive disorder symptomatology. This finding of comorbid alcohol dependence and psychopathology among methadone maintenance treatment clients suggests that both clients' health and methadone maintenance treatment participation and completion rates may be compromised. Alcohol dependence and psychopathology among methadone maintenance treatment clients should be considered when providing effectively targeted services to the drug using population.

Within‐ and between‐ subject variability in methadone pharmacokinetics and pharmacodynamics in methadone maintenance subjects

To investigate within- and between-subject variability of the pharmacodynamics and pharmacokinetics of (R)- and (S)-methadone in methadone maintenance subjects at steady-state. Six non-holder subjects were studied on three occasions at 7-16 day intervals; doses (20-170 mg/day) remained unchanged. Blood samples and pharmacodynamic data were collected 10-12 times over a 24-h inter-dosing interval. All pharmacodynamic data were expressed as the area under the end-point versus time curve. Using analyses of variance with mixed effects, best estimates were made of the ratio of between- to within-subject variation, with corresponding 95% confidence intervals (CI) for within-subject variation at the average value. Subjects were relatively consistent between occasions, whereas there was much greater between-subject variability (P < 0.02) for all measures. Estimates of the ratio of between- to within-subject variation ranged from 2.2-12.8 for pharmacodynamic measures, and 1.3-7.9 for pharmacokinetic parameters. For pain, total mood disturbance, withdrawal, pupil size and respiration rate, 95% CI for within-subject measures ranged < or = 2-fold, while this was greater for subjective direct opioid effects (4.2-fold). For CL/F of the active (R)-methadone, the variance ratio was 4.9 (P < 0.0003), with 95% CI for within-subject measures ranging < or = 2-fold. (S)-methadone CL/F demonstrated greater within-subject variability (3.4-fold), possibly contributing to a smaller (2.7; P < 0.0003) ratio of between- to within-subject variance. Non-holder methadone maintenance treatment participants appear to respond consistently with respect to pharmacokinetics and pharmacodynamics over a 1-2 month period. Such knowledge may help prescribers to determine whether alternative dosing regimens or treatments might be more appropriate in this population.

Evaluation of levo-alpha-acetylmethdol (LAAM) as an alternative treatment for methadone maintenance patients who regularly experience withdrawal: a pharmacokinetic and pharmacodynamic analysis

The aim of this study was to determine if substitution of daily methadone with second daily levo-alpha-acetylmethadol (LAAM) would convert non-holders on methadone into holders on LAAM, and to compare plasma concentration–time profiles of ( R)-methadone with LAAM and its two metabolites. Sixteen stable methadone maintenance treatment participants (non-holders, n=8) were randomly allocated to continue methadone for 3 months or switch to LAAM for 3 months, and then crossed over to the alternative drug for 3 months. At steady state, there were two testing sessions (24 h for methadone and 48 h for LAAM), during which opioid withdrawal severity, respiration rate and pupil diameter were measured 10–11 times and venous blood was collected 13–15 times. Ten age- and gender-matched controls underwent one 48-h test session. Areas under the withdrawal severity score versus time curve (AUC 0–47 hours for LAAM and controls; AUC 0–24 × 2 for methadone) were similar in holders on methadone and LAAM ( P=0.62), but were greater in non-holders when they were taking methadone than LAAM ( P<0.001). Respiratory depression and pupillary constriction were similar for LAAM and methadone. In comparison to ( R)-methadone, plasma nor- and dinor-LAAM concentrations fluctuated little over the dosing interval. LAAM converted methadone non-holders into LAAM holders. LAAM may therefore be useful in selected MMT non-holders and improve retention in opioid treatment programs.

Prevalence and correlates of HCV infection among methadone maintenance attendees: implications for HCV treatment

The HCV epidemic is thriving among often disadvantaged drug users. Current drug or alcohol use and underlying mental illness are contraindications for HCV treatment according to HCV treatment guidelines put forth by the U.S. National Institutes of Health. The authors determined the prevalence and the correlates of HCV infection among methadone maintenance treatment (MMT) participants in Baltimore, MD, USA and assessed the feasibility and public health importance of providing HCV treatment to drug users in this setting. Self-reported HCV infection and barriers to medical care were identified by an interviewer-administered survey. Individuals unaware of their HCV serostatus received an anti-HCV antibody EIA test. Correlates of HCV infection and barriers to HCV treatment were explored using logistic regression. To date, among 558 MMT participants, HCV prevalence was 64.7% and exceeded 90% among individuals reporting ever injecting drugs or sharing equipment. Factors independently associated with prevalent HCV infection included: increasing age (30–39 years: AOR: 0.82, 95% CI: 0.28, 2.42; 40–49 years: AOR: 3.42, 95% CI: 1.17, 9.99; 50+ years: AOR: 5.83, 95% CI: 1.70, 20.0); annual income of less than or equal to $5000 (AOR: 2.04, 95% CI: 1.23, 3.39); HIV infection (AOR: 2.11, 95% CI: 1.03, 4.36); prior HBV-infection, (AOR: 13.3, 95% CI: 6.53, 27.2); HBV immunisation (AOR: 3.60, 95% CI: 2.07, 6.27); years in MMT (AOR: 1.13, 95% CI: 1.03, 1.24); using drugs but not injecting in past month (AOR: 0.49 95% CI: 0.28, 0.87) and injecting drugs in past month (AOR: 6.5, 95% CI: 2.74, 15.4); and reporting a mental health problem (AOR: 2.86, 95% CI: 1.14, 7.20). Four barriers—lack of medical insurance, current alcohol or drug use and mental illness—would prevent 77% of the MMT participants from accessing HCV medical care and treatment according to criteria specified by NIH HCV treatment guidelines. MMT programmes represent an opportunity to counsel, screen, evaluate and provide ongoing HCV medical care and treatment.

Drug abuse, methadone treatment, and health services use among injection drug users with AIDS

This paper compares health care use across subgroups of injection drug users (IDUs) with AIDS, as defined by current drug abuse status and participation in methadone maintenance treatment (MMT), using surveillance-identified IDU status and health care claims data. Merged Medicaid and AIDS surveillance data were analyzed using ordinary least squares regression, simple logistic regression and multinomial logistic regression. Consistent MMT was more likely among women, Whites and older subjects. Monthly total expenditures and inpatient expenditures were significantly lower for IDUs in MMT than for IDUs with claims indicative of current drug abuse. Consistent participation in MMT was associated with a higher probability of antiretroviral use and, among antiretroviral users, more consistent use of antiretrovirals. Merged administrative data sets can be an important data source that illuminate the relationships among drug abuse, drug treatment, and HIV-related health care. For AIDS-infected IDUs, consistent MMT may lower barriers to receipt of appropriate HIV-related health care and reinforce adherence to medical recommendations.

Drug abuse, methadone treatment, and health services use among injection drug users with AIDS

This paper compares health care use across subgroups of injection drug users (IDUs) with AIDS, as defined by current drug abuse status and participation in methadone maintenance treatment (MMT), using surveillance-identified IDU status and health care claims data. Merged Medicaid and AIDS surveillance data were analyzed using ordinary least squares regression, simple logistic regression and multinomial logistic regression. Consistent MMT was more likely among women, Whites and older subjects. Monthly total expenditures and inpatient expenditures were significantly lower for IDUs in MMT than for IDUs with claims indicative of current drug abuse. Consistent participation in MMT was associated with a higher probability of antiretroviral use and, among antiretroviral users, more consistent use of antiretrovirals. Merged administrative data sets can be an important data source that illuminate the relationships among drug abuse, drug treatment, and HIV-related health care. For AIDS-infected IDUs, consistent MMT may lower barriers to receipt of appropriate HIV-related health care and reinforce adherence to medical recommendations.